Contributing lives, thriving communities
Report of the National Review of Mental
Health Programmes and Services
Volume 1
Strategic Directions
Practical Solutions 1–2 years
About this Review
.............
The Commission has considered the Terms of Reference in the context of the Contributing Life
framework: the right of all Australians to lead a full, contributing life, to flourish and to participate in their
community. This includes population groups with a greater burden of mental ill-health and disadvantage
and which, as a result, need specific attention: Aboriginal and Torres Strait Islander people; people living
in rural and remote regions; those who are marginalised due to their sexuality, gender, cultural
background or their job; people who have difficulties with alcohol or other drugs; and people living with
an intellectual disability. (Page 17)
Rates and impacts of mental illness and suicide
................
Our work has identified that many people with mental ill-health face compounding disadvantage—
particularly Aboriginal and Torres Strait Islander people, people living in rural and remote regions, those
who are marginalised due to their sexuality, gender, cultural background or their job, people who have
difficulties with alcohol or other drugs, people living with an intellectual disability and people who
experienced childhood trauma.
(p19)
Gaps
..............
There also are gaps in the provision of specialised supports or programmes for other at-risk population
groups, including Aboriginal and Torres Strait Islander people, people in rural and remote areas, people
who identify as lesbian, gay, bisexual, transgender or intersex, and people who endure discrimination or
are marginalised and suffer poor mental health as a result. This includes people from culturally and
linguistically diverse (CALD) communities as well as people who have particular mental health needs, such
as people with intellectual disability, people with childhood experience of trauma or people caught in the
criminal justice system. These gaps were highlighted in submissions to the Review.
(p34)
Recommendation 17:
Use evidence, evaluation and incentives to reduce stigma, build capacity and respond to the diversity
of needs of different population groups.
How this will be achieved
10.
PMHNs and LHNs should work together to identify local clinicians to champion a multidisciplinary team approach to coexisting intellectual disability and mental health.
(p106)
JS note – Primary and Mental Health Networks are a recommended renaming and extension of the
roles of the Government’s Primary Health Networks (formerly Medicare Locals).
Focusing on the needs of different population groups requires a person-centred approach where
programmes and services are:
- personalised: people can access support which is tailored to their preferences and their
whole-of-life needs
- consistent: people can access a consistent professional or team of supports they feel they
can build trusting relationships with over time, and who have the skills, knowledge and
approach that match the person’s needs
- respectful: people can access a professional or support team that demonstrates genuine
care, listens without judgement and is willing to work alongside them to achieve their hopes
and aspirations
- capacity building: people can access sufficient affordable support to enable them to cope
sustainably over the long term
- integrated: people can access non-clinical supports and clinical supports as part of a
spectrum of services which collaborate around a person and their family to address mental
health and social or economic circumstances at the same time.
People in all circumstances in life have a right to expect a just and fair approach which reflects
these principles.
There are differences in need and experience between different population groups; for example,
men and women face different risks to their mental wellbeing.
Emphasis needs to be applied to the needs of population groups where there are particular gaps
and barriers to achieving a contributing life.
These issues are covered in more detail in Volume 2 (Chapter 3). The various groups include (but
are not limited to):
Intellectual disability and mental health
Intellectual disability (ID) often co-occurs with mental health problems,77 but the two are

usually treated in isolation. Often the mental health needs of a person with ID go unrecognised
and there are a limited number of professionals with knowledge of how mental health problems
can manifest in this group. Specialist intellectual disability services and professionals are lacking
across Australia, but the Commission received evidence of promising approaches being used on
a limited scale. In South Eastern Sydney and Illawarra Local Health District, for example, multidisciplinary teams with expertise in all areas of ID health, including mental health, have been
established and driven by local clinicians with an interest in ID.
(p107)
Other areas for action:
.................
Interrelated needs: explore opportunities for joint care planning between mental health and
intellectual disability services, and between mental health and substance use services, to provide
a truly ‘no wrong door’ holistic response to people with concurrent needs.
(p108)
Recommendation 22:
Improve education and training of the mental health and associated workforce to deploy evidencebased treatment.
How this will be achieved
1. Include in core curricula for those who will come into contact with people with a mental health
problem education on how to better identify and understand mental health and trauma informed
care: adopt person and family-inclusive practice and manage all the person’s health needs—mental
health, physical health and coexisting disorders or conditions including drug and alcohol difficulties,
or intellectual and developmental disability.
(p121)
Attachment C:
Strategic Plan Years 1 and 2
Immediate Priorities
Recommendation 17
Use evidence, evaluation and incentives to reduce stigma, build capacity and respond to the diversity of needs
of different population groups.
Develop a framework
for the local response
to population specific issues,
to ensure integrated care
pathways, recognition of the
inadequacy of existing
pathways and a
person-centred response.
Health
Dept
Dec 2015
Governance
committees
PMHNs and LHNs
National agreements with
PMHNs and LHNs to reinforce
their responsibility to:
-work together to identify local
clinicians to champion a multidisciplinary
team approach to coexisting intellectual
disability and mental health
-...........
Volume 2
Every service is a gateway
Three dimensions of a person-centred approach
................
The Commission has found that there are three key dimensions of effective person-centred programmes
and services. ..........
The third dimension of effective person-centred programmes and services is ensuring that their design
and delivery is underpinned by the principle that each person seeking help brings with them their own
circumstances and experiences, some of which may present specific mental health challenges (including
stage of life, gender, sexuality and cultural background) or may be associated with increased mental
health risk (such as intellectual disability, chronic illness and substance abuse). To be truly person-centred,
services and programmes must be individually tailored to different life experiences and circumstances. A
one-size-fits-all approach is the direct opposite of the principle of person-centeredness.
(p38)
Tailoring support to each person’s life circumstances and needs
........... This final section illustrates the importance of tailoring person-centred support to a person’s
individual life experiences and circumstances.
We know that certain social, economic and other life circumstances are associated with particular mental
health challenges or support requirements.
We know that a person’s age, family situation, cultural background, gender and sexuality can
affect their experience of mental wellbeing and mental illness, as well as the types of support
they may find helpful and appropriate
We also know that particular life experiences have considerable impact on—and can be impacted
by—a person’s mental health, and therefore need to be considered at the same time. These
include intellectual disability, substance misuse and chronic physical illness or disability
(p50)
People with interrelated needs
Some life experiences and non-psychiatric health difficulties are closely associated with increased
likelihood of developing mental illness. This section uses a selection of these to show how our current
mental health policies and supports often fail to address commonly interrelated needs in a holistic way.
.........
Intellectual disability and mental health
Intellectual disability often co-occurs with mental health problems,41 but the two usually are treated in
isolation. Often the mental health needs of a person with an intellectual disability go unrecognised. There
are a limited number of professionals with knowledge of how mental health problems can manifest in
this group of people. An Australian study which followed people with an intellectual disability for 14 years
found that during the entire period, only ten per cent of those who also had a mental illness received
access to an intervention for that illness.42 Addressing problems in isolation in this manner does not
improve overall quality of life because the difficulties posed by other problems continue.
‘Communication between the mental health and disability sector is often very poor … generic mental
health services are reluctant to become involved with a person with [intellectual disability and mental
health problems]. The conclusion drawn by these services … is that “it’s not mental health, it’s
behavioural.” Consequently, services advocate that this group is not their concern, despite evidence to
the contrary.’
Submission from Queensland Centre for Intellectual and Developmental Disability (QCIDD)
Multiple research groups dedicated to intellectual disability research, as well as several professional peak
bodies, submitted recommendations to the Review for improved service responses to these co-occurring
needs. These included a cross-agency agreement for collaborative working—including a shared care
plan—between disability and mental health services; a national network of medical and allied health
professionals who have expertise in intellectual disability and mental health to act as a consultancy to
‘mainstream’ mental health services; mandatory basic training in intellectual disability for frontline health
workers and mental health professionals; measures within mental health organisations to address
inequity of access for people with an intellectual disability; improved epidemiological data collection and
linkage; and greater research into the experiences and needs of people with co-occurring intellectual
disability and mental illness.
Specialist intellectual disability services and professionals are lacking across Australia, but we have
received evidence of promising approaches being used on a limited scale. In South Eastern Sydney and
Illawarra Local Health District, for example, multi-disciplinary teams with expertise in all areas of
intellectual disability health, including mental health, have been established and driven by local clinicians
with an interest in intellectual disability. Such comprehensive integrated approaches to intellectual
disability health need to be recognised and encouraged at a national level.
(p61)
Actions
Interrelated needs: explore opportunities for joint care planning between mental health and
intellectual disability services, and between mental health and substance use services, to provide a
truly ‘no wrong door’ holistic response to people with concurrent needs.
(p63)
Gaps in programmes and services
While duplication was identified in the evidence submitted to the Review, gaps in service provision were
more commonly cited.
.......... The major ones are a lack of:
service provision which effectively addresses interrelated health needs concurrently. (Particular
examples commonly cited were intellectual disability with mental health problems, and
substance misuse with mental health problems.)
(p159)
Volume 3
What people told us – analysis of submissions to
the review
Executive summary
People with interrelated and complex difficulties which include a mental health problem (including those
with substance misuse, history of trauma and abuse, or intellectual disability) are also poorly served by a
lack of collaboration across agency or disciplinary boundaries—each of their intertwined problems is
viewed and treated in isolation.
(p5)
Lack of appropriate services for interrelated needs
Many submissions referred to the seeming inadequacy of current support arrangements in addressing
interrelated needs in a way that ensures the needs of the whole person are met. Respondents told us
that this is especially the case where mental illness occurs at the same time as other social, health and
economic problems, or in the context of particular life experiences. For example, people who experience
a substance abuse issue or a physical or intellectual disability as well as their mental health problem may
find that the mutually influencing nature of these difficulties is not recognised and that different problems
are either not addressed or are addressed in piecemeal fashion. There is also the risk that the person will
be considered as another agency’s business and fall through the gaps between services.
(p83)